Diagnostic ultrasound ( PDFDrive )

CHAPTER 14 The Peritoneum 523
FIG. 14.36 Sclerosing Peritonitis. Transverse ultrasound image of
the midabdomen shows extensive, complex, septated ascites.
FIG. 14.38 Inlamed Fat With Phlegmon. Oblique sagittal ultrasound
image of the right lower quadrant shows the thickened terminal ileum
with echogenic inlamed fat and hypoechoic perienteric phlegmon formation
(arrow).
F
FIG. 14.37 Inlamed Fat. Transverse ultrasound image of the right
lower quadrant shows echogenic inlamed fat (F) associated with a long
segment of thickened terminal ileum in patient with Crohn disease.
and occasionally laparoscopic evaluation may be necessary, with
biopsy of the peritoneum to rule out tumor.
Another possible sonographic inding in endometriosis is the
presence of hypoechoic endometrial plaques on the serosal
surface of pelvic bowel loops or urinary bladder. hese plaques
may tether the wall of the afected organ and show low with
color Doppler imaging. hey are best demonstrated with the
transvaginal probe (Fig. 14.41, Videos 14.9 and 14.10). “he
sliding sign” is proving useful at predicting pouch of Douglas
obliteration in women caused by endometriosis. 76-78
LEIOMYOMATOSIS PERITONEALIS
DISSEMINATA
Leiomyomatosis peritonealis disseminata is a relatively rare
clinical entity characterized by multiple nodules, mainly the
result of smooth muscle proliferation over the surface of the
FIG. 14.39 Right-Sided Segmental Omental Infarction. Sagittal
image of the right midabdomen shows an ovoid echogenic mass
(arrowheads). This was the site of the patient’s maximal tenderness.
peritoneal cavity. 79 Leiomyomatosis peritonealis disseminata oten
mimics a malignant process, but the diagnosis is easily made
with biopsy.
Typically, leiomyomatosis peritonealis disseminata is an
incidental inding at imaging or during procedures such as
laparoscopy, cesarean section, laparotomy, and postpartum tubal
ligation. 29 It occurs mainly in women, primarily during the
reproductive period. Exposure to estrogen seems to play an
etiologic role. Many patients have uterine leiomyomas as well.
Conservative care is generally indicated. When leiomyomatosis
peritonealis disseminata occurs during pregnancy or with the
oral contraceptive use, it may regress spontaneously ater delivery
or with oral contraceptive discontinuation. Malignant transformation
of leiomyomatosis peritonealis disseminata remains uncertain.
In a few isolated cases, malignant leiomyosarcomas have been